Dataset Information

The Importance of Subclavian Angiography in the Evaluation of Chest Pain: Coronary-Subclavian Steal Syndrome.

ABSTRACT: Routine preoperative screening for the presence of brachiocephalic disease using ultrasonic duplex or angiography is a cost-effective and essential means to prevent the development of rare occurrences of coronary-subclavian steal syndrome.

SUBMITTER: Kinno M

PROVIDER: S-EPMC6372034 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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The Importance of Subclavian Angiography in the Evaluation of Chest Pain: Coronary-Subclavian Steal Syndrome.

Kinno Menhel M Niazi Osama Tariq OT Lorin Jeffrey D JD Chandrasekaran Kulandaivelu K

Federal practitioner : for the health care professionals of the VA, DoD, and PHS 20170101 1

Routine preoperative screening for the presence of brachiocephalic disease using ultrasonic duplex or angiography is a cost-effective and essential means to prevent the development of rare occurrences of coronary-subclavian steal syndrome. ...[more]

PMID: 30853779

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Project description:BackgroundIt is unclear whether an evaluation incorporating coronary computed tomographic angiography (CCTA) is more effective than standard evaluation in the emergency department in patients with symptoms suggestive of acute coronary syndromes.MethodsIn this multicenter trial, we randomly assigned patients 40 to 74 years of age with symptoms suggestive of acute coronary syndromes but without ischemic electrocardiographic changes or an initial positive troponin test to early CCTA or to standard evaluation in the emergency department on weekdays during daylight hours between April 2010 and January 2012. The primary end point was length of stay in the hospital. Secondary end points included rates of discharge from the emergency department, major adverse cardiovascular events at 28 days, and cumulative costs. Safety end points were undetected acute coronary syndromes.ResultsThe rate of acute coronary syndromes among 1000 patients with a mean (±SD) age of 54±8 years (47% women) was 8%. After early CCTA, as compared with standard evaluation, the mean length of stay in the hospital was reduced by 7.6 hours (P<0.001) and more patients were discharged directly from the emergency department (47% vs. 12%, P<0.001). There were no undetected acute coronary syndromes and no significant differences in major adverse cardiovascular events at 28 days. After CCTA, there was more downstream testing and higher radiation exposure. The cumulative mean cost of care was similar in the CCTA group and the standard-evaluation group ($4,289 and $4,060, respectively; P=0.65).ConclusionsIn patients in the emergency department with symptoms suggestive of acute coronary syndromes, incorporating CCTA into a triage strategy improved the efficiency of clinical decision making, as compared with a standard evaluation in the emergency department, but it resulted in an increase in downstream testing and radiation exposure with no decrease in the overall costs of care. (Funded by the National Heart, Lung, and Blood Institute; ROMICAT-II ClinicalTrials.gov number, NCT01084239.).

Dataset Information

The Importance of Subclavian Angiography in the Evaluation of Chest Pain: Coronary-Subclavian Steal Syndrome.

Publications

The Importance of Subclavian Angiography in the Evaluation of Chest Pain: Coronary-Subclavian Steal Syndrome.

Similar Datasets

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